As the Canadian health-care system prepares for a potential second wave of COVID-19, there are lessons to be learned from a recent study published in the Journal of Medical Internet Research about a telemedicine practice in Wuhan, China that employed a social media app to monitor patients in the early days of the pandemic.
In January 2020, Wuhan’s local medical capacity was quickly overwhelmed by the large number of patients who swarmed to hospitals for help. Many health-care workers were infected with COVID-19 and medical care supplies were depleted. To prevent the health-care system from collapse, China advocated for infected patients with mild symptoms to stay home and self-quarantine. A small percentage of home-quarantined patients – approximately one to four per cent – eventually developed severe or critical conditions, yet those patients did not exhibit different onset symptoms.
To address this dilemma, seven medical workers at Tongji Medical School Hospital, including two doctors and three nurses, set up a group chat on WeChat, a popular social media app in China. They invited patients at their clinic who were experiencing mild symptoms of COVID-19 but could not be diagnosed or treated to join the group.
Upon sign-up, individuals were required to fill in a quarantine assessment questionnaire, and then to fill in a monitoring form on WeChat every day to self-assess their conditions. The form updated the medical team on a number of symptoms including fever, dyspnea, lack of strength and muscle soreness. Based on the update, the medical workers analyzed the symptom changes and used the individual chat function to provide instructions and suggestions to patients. A telemedicine system was thus established.
In total, 188 home-quarantined individuals joined the telemedicine system, including 74 patients who were eventually diagnosed with COVID-19. For the 114 individuals who may have just been experiencing cold or flu symptoms, the telemedicine system prevented possible cross-infection by reducing their unnecessary clinic visits.
Out of the 74 positive COVID-19 patients, six progressed to severe or critical conditions during home quarantine. Thanks to the telemedicine system, which enabled the medical team to take note of their deteriorating conditions, all six patients were admitted to the hospital in a timely fashion. One patient was on ECMO support for 17 days, but all 74 patients eventually recovered.
The telemedicine system has done much more than save six patients’ lives or prevent 114 people from infection. According to the study, several patterns of symptom changes were identified through vigorous statistical analysis as predictors for disease progression, which shed light on further understanding of the virus.
In addition, the WeChat group worked as a support group that facilitated social interactions among those isolated and infected individuals. Patients shared songs, photos and recovery news to cheer each other on, largely alleviating their psychological stress. The medical team included a rehabilitation physician and a psychologist who provided formal consultation on recovery exercises and mental health issues.
The telemedicine system also benefited the Chinese health-care system at large, as this model can enlist the help of infected but recovered medical staff who are self-quarantining at home. Indeed, one nurse on the original medical team in the study was infected with COVID-19, and she worked from home to support the telemedicine system. Thus, in the case that COVID-19 surges again in Canada, this model could be used to ease shortages in the medical workforce and free up workers to fight on the frontline.
With the wide availability of social media apps, this model can be easily adopted around the world. It does not matter which app is used. As long as home-quarantined patients can use the same platform to form a virtual support group and have timely access to medical professionals, the detrimental impacts of COVID-19 on physical and mental health can be greatly contained.
Martin Qiu, associate professor of Business at Wilfrid Laurier University’s Lazaridis School of Business and Economics, helped develop the telemedicine system and analyze the data.